Table Of ContentThe Caring Person's Guide
to Handling the
Severely Multiply Handicapped
Rachel Golding
and
Liz Goldsmith
Illustrations by Martin Battye
M
MACMILLAN
© Rachel Golding and Liz Goldsmith 1986
Illustrations © Martin Battye 1986
All rights reserved . No reproduction, copy or transmission
of this publication may be made without written permission .
No paragraph of this publ ication may be reproduced, copied
or transmitted save with written permission or in accordance
with the provisions ofthe Copyright Act 1956 (as amended ).
Any person who does any unauthorised act in relation to
this publication may be liable to criminal prosecution and
civil claims for damages .
First published 1986
Publ ished by
MACMILLAN EDUCATION LTD
Houndmills, Basingstoke, Hampshire RG21 2XS
and London
Companies and repre sentatives
throughout the world
British Library Cataloguing in Publication Data
Golding ,R.
The caring person's guide to handling the
severely mult iply handicapped .
1. Handicapped-Care and treatment
I. Title II . Goldsmith, L.
362.4 HV1568
ISBN 978-0-333-38619-4 ISBN 978-1-349-07780-9 (eBook)
DOI 10.1007/978-1-349-07780-9
Contents
Foreword iv Part Two: Treatment 41
Information Vll
Introduction to Part Two 41
Positioning 42
Encouraging Normal and Active Movement 48
Introduction to the Guide 1
Preventing Deformity 56
Why has this Guide been Written 1 Lifting and Handling 59
What does this Guide Consist of? 2
Who is the Key Worker? 2 Part Three: Care Review 61
Who is the Co-worker? 2
Introduction to Part Three 61
Use of Terms 2
The Care Review 62
The Illustrations 2
Part Four: Planning a System 65
Introduction to Part Four 65
Part One: Physical Assessment 3
Implementation 65
Introduction to Part One 3 Evaluation 67
What does this Assessment Cover? 3
Assessment of Muscle Tone 4 LookingAhead 68
Assessment of Deformity 6 Key Worker's Progress Chart 69
Assessment of Movement 12 ShoppingList 70
Problems Page 38 UsefulFurtherReading 71
III
Foreword
This guide is by practitioners in the Mental Hand- through, answer the questions, seek for the next
icap Service for practitioners in that service. It is a piece of information and finally decide on the
guide that demands a response from those who read optimal means of intervention.
it and in this way the lives of many mentally Much of the time of a Physiotherapist in the
handicapped people will improve and the deformi- Mental Handicap Service is rightly spent in increas-
ties seen so often in our long-stay wards will be ing the skills in physical care of other caring staff
minimised and possibly prevented in future genera- and the parents. This guide will greatly support that
tions. endeavour, allowing those who are untrained in
In the past, it has proved difficult to attract physical care to be sure of the aims of treatment, to
Psychologists and Physiotherapists into the Mental avoid harmful interventions and choose those that
Handicap Service. What could be done for mentally will maximise the limited skills of the mentally
handicapped adults? Surely profoundly handicap- handicapped person.
ped people do not present a therapeutic challenge? Attitudes to profoundly handicapped people are
An attitude of therapeutic nihilism and custodial still tinged with pessimism. This guide will help to
inactivity was prevalent and many profoundly make progress with the treatment of profoundly
handicapped people with unnecessary handicaps handicapped people; it will help to convince both
spent their lives without purpose or happiness. ourselves as well as others that improvements are
This activity guide, written by a Clinical Psycho- possible and that good physical care is the basis for
logist and a Physiotherapist, both of whom have all other areas of development. The authors are to
extensive experience with profoundly and multiply be congratulated on the production of a guide which
handicapped people, is for anyone who looks after will have far-reaching effects in improving the lives
such a person , and is to help them to use their time of those who present us with so many challenges.
and skills more effectively, to minimise or prevent
deformities and to position the person advan-
tageously for his well-being and development. The Joan Bicknell
guide is in several sections, the design being based Professor of the Psy chiatry
on problem orientation so that the user can work of Mental Handicap
IV
r -
I
/
/
.I \
/ \I
/
\
\
'How best to care for the multiply handicap-
ped, and how to enable them to live lives that
are as rich and meaningful as possible, has
. . . .. . become not merely an ethical, psycho-
logical and nursing problem affecting only a
few, but also a social problem affecting sub-
stantial numbers of people.'
(Prof. J. Tizard in his Foreword to
Maureen Oswin (1978). Children Living in Long Stay
Hospitals,
Spastics International Medical Publications,
Research Monograph 5,
Heinemann, London)
v
Information
Nameofpatient _
Date of birth
Address _
Attendance at school, ATe, etc. (please specify place attended and time)
If your patient lives in hospital, date of admission
Name of key worker _
Name of co-worker _
Physiotherapist _
Other professionals involved (e.g. doctor, teacher, psychologist , social worker, occupational
therapist, etc.) _
VII
Introduction to the Guide
Why has this Guide been Written?
This guide has been written to help anyone working with the severely multiply handicapped to be able to do
the following:
1. Learn how to identify the physical problems 2. Discover how these problems affect the pa-
of the patient. tient and what will happen if they are not
treated.
3. Find out what methods could be used to treat 4. Develop a plan of action whereby the needs
some of these problems. which have been identified are met.
1
lJ...
This guide is not designed to reduce the need for a authority already in existence in her place of work .
physiotherapist but rather to enable the care giver At the same time, it is recommended that the role of
and physiotherapist to communicate more effective- key worker should be respected by those in author-
ly for the patient's benefit. ity as one which encourages the care giver to take
Your patient is likely to have many problems that greater responsibility for her patient.
are associated with his physical and mental hand-
icaps and are not covered in this guide . For exam-
ple, he may need special help with feeding, he may Who is the Co-worker?
have behaviour problems, he may have difficulty in
hearing or seeing. The co-worker has a similar role to that of the key
worker and it is her job to ensure that recommenda-
Yourpatient's emotional, social and educational needs tions are carried out when the key worker is not
are ofno less importance than hisphysical care. present. In the hospital setting the co-worker is
most likely to be a member of the opposite shift to
However, good physical management provides a
the key worker.
sound foundation for work on these additional areas
of need and should increase the chances of success.
For example, a good sitting position and correct Use of Terms
support make feeding easier; certain positions and
aids make it possible for the patient to use his hands Throughout this guide, the person being assessed is
to play. The Caring Person's Guide has been de- taken to be male and is referred to as the 'patient'
signed specifically to help with the physical manage- and the care giver is taken to be female. The
ment of the patient and thus create a useful basis for decision to call the person being assessed the 'pa-
further work. tient ' was made after considerable thought and
discussion. This term was felt to be the most
appropriate, not because the authors adhere to the
medical model of care, but because the term sug-
What does this Guide Consist of?
gests the continuing need for treatment. The deci-
sion to refer to the patient as male and the care giver
This guide is divided into four parts:
as female was made for purposes of simplicity and
Part 1 Physical Assessment clarity. The illustrations are, however, based on real
people of both sexes.
Part 2 Treatment
Part 3 Care Review
The Illustrations
Part 4 Planning a System
Since the illustrations are derived from our work
with and observation of real people , most of whom
Who is the Key Worker? have not had the benefit of consistent treatment , the
pictures also demonstrate problems of deformity
The key worker is the person whose job it is to and abnormality of movement. These illustrations
make sure that this guide has been filled in correctly are intended to give encouragement and ideas to
and that any recommendations are carried out. those working with similar populations and are not
Since this guide is primarily for use in mental intended as a model of perfection for treatment.
handicap hospitals, the key worker is most likely to Only by working through the guide with the help of
be a nurse. The key worker should work in much your physiotherapist, and by seeking advice from
the same way as a parent to ensure that the patient is others , can the best possible treatment be devised
well cared for and happy. for your patient. None of the examples discussed or
It is recommended that the key worker should illustrated bears any relation to particular indi-
work through those channels of communication and viduals.
2
Part One
Physical Assessment
'We (have) emphasised the importance of carrying out a detailed assessment of the needs of each individual
resident: this applies with even greater force to the profoundly handicapped.'
Helping Mentally Handicapped People in Hospital: A Report to the Secretary of State
for Social Services by the National Development Group for the Mentally
Handicapped, DHSS 1978.
Introduction to Part One
HOW DO I COMPLETE THIS ASSESSMENT? 3. Remember to be sensitive to your patient's
feelings and to talk to him as you work.
1. Read the description at the start of each section 4. If you feel that your patient is in pain or is
carefully. frightened, do not continue with that part of
2. Make full use of the forms to explain your the assessment but try again on another day. If
findings or to mention any difficulties you have you get the same response when you try again,
in carrying out the assessment. it is important not to try to pursue that area
Don't worry if a comment looks silly when further but to make a note in the comments
written down; remember that the more in- section of the reasons why that section has not
formation you put on the forms the easier it will been completed. Remember, this assessment is
be when you go on to plan treatment. a means to an end-to help you to understand
your patient's physical problems and to care for
Some of the sections are easier to fill in if you his needs in the best way possible .
can compare your patient's limbs with those of
a normal person. Therefore it may be helpful to
have another member of staff on hand to assist WHAT EQUIPMENT DO I NEED?
you .
You will need some equipment to do this assess-
ment: a mat, a wedge, possibly a roll, a balance
board and a special chair. It may be that during the
assessment you will identify a need for special
equipment, in which case make a note of it and
mention it at the care review meeting. It can then be
placed on the shopping list.
What does this Assessment Cover?
This physical assessment covers three main areas :
1. Muscle Tone
2. Deformity
3. Movement
These will be dealt with in separate sections. There
are various diagrams, tables and illustrations to help
you .
3
